Background & Aims

Abdominal pain frequently occurs in postpartum women undergoing cesarean section. During this period, pain is a limiting factor to perform basic activities, such as caring for the baby. Knowledge of the characteristics of pain in this population and the factors associated with it are important for adequate postnatal analgesia. The objective of this study was to characterize the somatosensory and functional aspects of pain in postpartum women undergoing cesarean section.

Methods

A cross-sectional study was carried out with 52 postpartum women undergoing cesarean section. Sociodemographic data of the postpartum woman (age, ethnicity, educational level, marital status, occupation, body mass index, alcohol use, smoking, practice and level of physical activity), obstetric data (gestational age, parity, type of previous birth, complications during pregnancy, induction of labor) and newborn data (weight, head and chest perimeters, APGAR score) were collected. Superficial and deep pain intensity at rest and movement (Numerical Rating Scale), pressure pain threshold (algometry) and cutaneous sensory threshold (esthesiometry) above and below the surgical incision and 6 cm above the umbilical scar, temporal summation measurement (algometry) at a central point 2.5 cm above and below the surgical incision were assessed. Range of motion of anterior flexion and trunk rotation (fleximetry) were assessed and execution time and pain intensity during walking (TUG test).

Results

Women were 26 ± 10.8 years old, single (69.2%), housewives (61.5%), non-smokers (94.2%) or alcoholics (75%). Incisional pain intensity at rest (0.0±3.0) indicated adequate analgesia, however the intensity of incisional pain in movement (6.0±2.0) showed a predictive factor for chronification in the postpartum period, the same occurred for deep pain at rest (0.0±3.8) and movement (0.0±8.0). There was a moderate correlation between the intensity of pain when performing the anterior flexion movement of the trunk and the LDP above the incision (r?0.532; ?=0.439 p=0.006). There was a moderate correlation between the intensity of incisional pain at rest and the intensity of deep pain at rest (r=0.536; ?=0.552; p=0.001) and a strong correlation between the intensity of deep pain at rest and in movement (r=0.783; ?=0.519; p=0.001). There was a moderate and inverse correlation between the total time to perform the TUG and the degree of trunk flexion ROM (r=-0.661; ?=-0.468; p=0.001).

Conclusions

It was observed that post-cesarean section pain presents characteristics that impact not only on sensory variables, but also on the functionality of trunk movement and gait in these postpartum women, which confers the need for early analgesic intervention in this population.

References

BORGES, Natália Carvalho et al. The incidence of chronic pain following Cesarean section and associated risk factors: A cohort of women followed up for three months. PloS one, v. 15, n. 9, p. e0238634, 2020.
GUEVARA, Jennifer et al. Predicting pain after Cesarean delivery: pressure algometry, temporal summation, three-item questionnaire. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, v. 68, n. 12, p. 1802-1810, 2021.
KINTU, Andrew et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC health services research, v. 19, n. 1, p. 1-6, 2019.
SHARPE, Emily E. et al. Recovery of physical activity after cesarean delivery and its relationship with pain. Pain, v. 160, n. 10, p. 2350, 2019.
LAVAND’HOMME, Patricia. Postoperative cesarean pain: real but is it preventable?. Current Opinion in Anesthesiology, v. 31, n. 3, p. 262-267, 2018.

Presenting Author

Isabela Azevedo-Santos

Poster Authors

Isabela Santos

PhD

Federal University of Sergipe

Lead Author

Akeline Santos PhD

Federal University of Sergipe

Lead Author

Renata Lotti PhD

Lead Author

Thiago Abner PhD

Tiradentes University

Lead Author

Josimari DeSantana

Federal University of Sergipe

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Abdominal and Pelvic Pain